Living With Arthritis Blog

Chronic Pain and Insomnia- Here’s Why You’re Tossing and Turning

Tammy Applegate dreams of sleep – when she dreams, that is. Most nights, she can’t sleep soundly; pain rousts her four or five times. She turns over, repositions the pillow under one shoulder – the only position that offers some relief – and waits for slumber to overpower her discomfort. “Sometimes it takes me so long to get comfortable that I stay awake anywhere from 30 minutes to a couple of hours,” says the Fort Worth, Tex., mother of four, who has mixed connective tissue disease and requires sleep treatments to resolve her issues with pain and sleep.

She’s got plenty of company. Insomnia – broadly defined as having trouble falling or staying sleep – affects anywhere from 10 to 40 percent of American adults, at least intermittently, according to population studies. It’s estimated that some 10 to 15 percent have long-term sleep problems (lasting more than a month).

If you have problems with pain and sleep that seem intractable, don’t lose hope. There are ways to improve your chances of getting a good night’s rest.

What Goes Wrong

Adults usually need between seven and nine hours of sleep a night. Ideally, that sleep comes in cycles, played out in roughly 90-minute segments throughout the course of a night. It includes rapid eye movement (REM) sleep, in which you dream, and four stages of non-REM sleep. First you enter several stages of non-REM sleep, descending from stages 1 and 2 into stages 3 and 4 – the deeper and more restorative stages. You then resurface and enter REM sleep. Then another 90-minute cycle starts.

Insomnia – the disruption of the sleep cycle – comes in two forms. Secondary insomnia is a side effect of another condition, illness or behavior. In addition to arthritis or fibromyalgia, for example, it can be caused by poor sleep hygiene; stress; and a range of medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and, for some people, statins (such as Lipitor and Zocor).

With primary insomnia, however, there is no clear cause as to why people can’t sleep. It may be triggered by a major stressful event or by disruptions in your sleep routine (caused by travel or work). Researchers are also examining whether some people simply are predisposed to insomnia.

Even normal aging takes a toll: As we grow older, we naturally get less restorative sleep and are more likely to wake up in the night – although the amount of sleep we need doesn’t change.

Just worrying about insomnia can make it worse, so that it becomes a self-fulfilling prophecy, says Art Spielman, PhD, a longtime sleep researcher and psychology professor at The City College of The City University of New York. “If you think you are not going to fall asleep, you don’t fall asleep,” he says.

The Sleep/Pain Cycle

Achieving restful sleep can be particularly difficult for people like Applegate who have chronic pain. “Pain is a lump of coal under your mattress,” says Spielman. “Even when you’re asleep, the mind can register pain.”

People may notice obvious signs of pain and sleep problems, such as not being able to fall asleep or waking up frequently due to discomfort, says Michael Smith, PhD, director of the sleep psychophysiology laboratory at Johns Hopkins University in Baltimore. Or – and Smith believes this may be more disabling – they have disruptions in the sleep cycle itself so that they sleep but don’t get enough deep sleep. They may be aroused during sleep and pushed from deep sleep into a lighter stage without ever knowing it. “Their deeper sleep is disrupted by arousals or outright awakenings,” Smith says. “They may sleep 10 hours but feel groggy and unrefreshed the next day.”

That also may be the case for people with fibromyalgia, who tend to have abnormalities in deeper-stage sleep. Researchers have explored whether sleep disorders cause the pain of fibromyalgia or vice versa, but it’s still not clear.

I firmly believe that lack of sleep was causing fibromyalgia for me. Once my arthritis pain was more controlled, I could sleep better, and the associated fibromyalgia went away. Not being able to sleep from pain is terrible. It totally compromises your emotional ability to cope with the uncertainty of RA, which in turn creates more stress hormones and worsens arthritis. It’s a vicious cycle, so I’ve learned I have to make sleep more of a priority (which is hard, when I am naturally a night owl!).

I can only lay down so long before the pain in my shoulders keep me awake and it is no use trying to sleep any longer. I either stay up or try again in an hour or so. The same holds true for sitting and standing. The only help as I see it is pain killers.

I live with severe RA and have been a secondary insomniac for years! For years, I have not been able to sleep in one position for an entire night’s sleep due to locking of my joints in my hands, shoulders, knees, feet. I continue to struggle to sleep for a solid 6-7 hours. Knowing how addictive sleep-aids and pain meds can be. I rotate between a sleep aid and pain meds. I don’t need these items daily and often times it’s 3am before I recognize I will not be able to sleep at all. I am fortunate to work for a flexible company that will allow me to take personal time or work a later shift.

I haven’t been able to sleep through the night for a very long time. Now I understand why. My right hip throbs and continuously I experience a burning sensation during the time I am lying down. There is no relief…there is only making it through the night. Sleeping on a flatter pillow seems to eleviate some of the discomfort but not all. I have RA and Osteosrthritis. HELP!!! I feel like a zombie during the day. Is there light at the end of this neverending tunnel?

I have been diagnoised OA and insomnia. I will fall asleep and about 2 hours later I will be uncomfortable and get excruciating pain in my left knee. I will put up with this pain it is like having a tooth ache pain in the inside knee. The family doc has given me sleeping pills and anti-inflamatory pills but I resist taking them. I am on crestor pill to control my chelestoral which I take every night before going to bed. I am lucky if I get more than 3 hours sleep a night. This pain in the knee started 4 months ago and hasn’t stopped.